Provider Demographics
NPI:1134601826
Name:GOODWIN, JON W III (PHD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:W
Last Name:GOODWIN
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2119 EDUCATION BUILDING
Mailing Address - Street 2:GEVIRTZ GRADUATE SCHOOL OF EDUCATION
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93106-1009
Mailing Address - Country:US
Mailing Address - Phone:708-856-9714
Mailing Address - Fax:319-356-2587
Practice Address - Street 1:2119 EDUCATION BUILDING
Practice Address - Street 2:GEVIRTZ GRADUATE SCHOOL OF EDUCATION
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93106
Practice Address - Country:US
Practice Address - Phone:805-893-8064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA090186103T00000X, 103TC0700X, 103TC2200X
CA32003103T00000X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical